Monthly Archives: December 2014

Denis Pushilin, a pro-separatist leader in southeast Ukraine, has said the Ukraine faces a ‘second Chornobyl’ due to Ukraine’s decision to use nuclear fuel supplied by Westinghouse for its Soviet-built nuclear power plants.

He said radiation has increased to 14 times the acceptable norm at the Zaporizhia nuclear plant. This is the largest nuclear power plant in Europe, and the fifth largest in the world.

The Russian news agency Interfax reported that in a statement on December 28, Pushilin said Ukraine faces “a second Chornobyl” due to Kyiv’s decision to use nuclear fuel supplied by Westinghouse — a reference to the deadly 1986 nuclear power plant accident that spead radioactivity over parts of Europe.

Pushilin said that “currently the level of radiation is 14 times higher than the acceptable norm” in the area around the Zaporizhzhya plant and that the problem started November 28 “after an unsuccessful attempt to replace rods in the Russian-made third block (reactor) with the product of the American company Western house.”

According to authorities, Unit 3 of the Zaporizhia plant suffered a short circuit on Nov. 28, and theis reactor was shut down for a week. Pushilin alleges that the reason for the shutdown was the unsuccessful replacement of Russian-made fuel rods with Westinghouse fuel rods.

Radiation levels were at 5.05 mSv/yr. The criterion for evacuation in Ukraine from Chernobyl was 5 mSv/yr.

This comes out to 0.58 μSv/hr. Presumably this does not include background radiation. According to the plant operator’s website, background radiation at the plant is 0.10 μSv/hr, which gives a 0.68 μSv/hr dose.

This is equivalent to the less contaminated parts of Fukushima prefecture. It might be around half the amount of Fukushima City. But it seems to be increasing.

Ukraine’s switch to the use of upgraded nuclear fuel from the United States at its nuclear power plants (NPP), built in the Soviet times, could threaten safety both at the domestic level and in Europe as well, the Russian Foreign Ministry said in a statement on Tuesday.

“Moscow was somehow alarmed as Ukrainian Prime Minister Arseny Yatsenyuk announced on December 30 the signing of an agreement with US company Westinghouse concerning nuclear fuel supplies for Ukrainian nuclear power plants,” the ministry said in its statement…

“It seems that the Chernobyl tragedy did not teach Kiev authorities any lessons concerning a scientifically feasible approach to the [peaceful] use of nuclear energy,” the Russian ministry said in its statement. “In might be in fact, that the nuclear safety is sacrificed for the sake of political ambitions or, even more, other tangible interests.”…

“Consequences of possible accidents and meltdowns [at nuclear power plants] will be in the full responsibility of the Ukrainian authorities and US suppliers of [nuclear] fuel,” the statement added.

Safety concerns regarding Ukraine’s switch to the US supplied nuclear fuel were repeatedly voiced by Russian experts and some officials, including by Sergey Kiriyenko, the head of Russian state-run nuclear corporation Rosatom.

So it seems that all 6 reactors will have their fuel rods replaced with Westinghouse fuel at some point. Crimea is nearby Zaporizhia, and it is now part of Russia. Irradiation of Russian citizens, especially due to a switch in fuel supplier from Russia to Westinghouse, would add even more tension to the Ukraine crisis, which is already threatening to lead to global nuclear war.

The reason Ukraine is switching to Westinghouse fuel is political. Russia has already agreed to supply its fuel to Ukraine, and there are no sanctions involved. Ukraine has become a vassal state to the West after the coup earlier this year. It is being used as a pawn, and a place to deploy missiles near the Russian border, in an encirclement strategy by the US and NATO.

In 2012, during a routine inspection, Energoatom reported that Westinghouse’s assemblies had structural damage. It had to swap those for Russian-made fuel assemblies, which the utility estimated cost it $170 million.

After a suit threatened by Energoatom, Westinghouse tried to make good on its deal and produced modified fuel rods for the Russian built VVER-440 reactors. These, too, were found defective.

Indeed, Westinghouse has not fared well in other markets dominated by Soviet built reactors. In 2000, it began supplying nuclear fuel to CEZ, a Czech utility, for two reactors that it helped to modify at CEZ’s Temelin station. In 2009, Russian company TVEL took that business away.

During a core reload in 2012 on the unit №2 and №3 YUNPP the mechanical damages
of TVS-W FAs have been found. Damages have been found at visual inspection of FAs. The some of spacer grids has been damaged. Breakages of SG fragments, squeeze, deformation of petals and an attrition have been detected. Two FAs are recognised as an unsuitable to the further operation, some FAs can be use in a core only after repair, a part of FAs it is ready to operation one cycle and then obligatory inspection at the stand of repair and inspection. The reasons of problems at a core reload and of defects of FAs:
− Lacks of a design of the top nozzle of the FA. The FAs are placing «one on another».
− Insufficient mechanical strength of SGs to radial and axial efforts.
− Lacks of a design of the bottom nozzle of the FAs. Corners, sharp edges increase probability of FAs damage at a core reload.
− Bending of FAs.
− Loading in transitive cycles of FAs of type TVSA for which the bending above design values and at the same time high rigidity of a skeleton also is typical. (Maximum design value of a FA bend is 7 mm. Maximum measurements value of blend is 29 mm [ZNPP, 7])…

The rods don’t fit right, lack the features needed for the Soviet-era equipment, and the boric acid formulas don’t work.

“Only one aspect is important: that the nuclear industry has absolute security priority,” Kiriyenko said. “If the nuclear industry begins to make decisions for political reasons, this already poses a threat.,” Kiriyenko said in April and voiced the same opinion two days ago addressing the 58th General Conference of the International Atomic Energy Agency (IAEA) in Austria’s Vienna…

Sergei Kondratyev, a senior expert with the Russian Institute for Energy and Finance, voiced concern over the sharp switch from Russian-to US-produced nuclear fuel as it could pose a threat to the safety of Ukrainian nuclear power plants, which were built in the Soviet Union era.

In an interview with ITAR-TASS Kondratyev said that Ukraine’s decision to switch to the US-produced upgraded nuclear fuel did not take into account technical characteristics and peculiarities of the Soviet-built NPPs.

“The current management of Ukraine’s Energoatom sets the main task to significantly reduce fuel purchases from Russia and switch to the US fuel,” he said. “However, such sharp alternation of nuclear fuel use could result in safety drop at the exploited nuclear power plants and this is definitely unacceptable.” (link)

Why There Is an Urgent Need to Widely Distribute the Myalgic Encephalomyelitis International Consensus Primer to Doctors

by Jerrold Spinhirne, December 17, 2014

A guest post today. With the radiation catastophes of Fukushima, WIPP, Honeywell, etc., and the enterovirus epidemics getting underway, proper diagnostic criteria is vital, and there is an immediate need to obtain biomarkers so that effective treatments can be found. The ICC is the only document I have found that describes this disease adequately.

The confusion and delay resulting from the recent December 9-10, 2014 National Institutes of Health (NIH) Pathways to Prevention (P2P) Workshop on “ME/CFS” and the issuance of the Agency for Healthcare Research and Quality (AHRQ) Evidence Report No. 219 “Diagnosis and Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome” [Smith, 2014] emphasize the urgent need for the 2011 Myalgic Encephalomyelitis: International Consensus Criteria (ICC) [Carruthers, 2011] and particularly the 2012 International Consensus Primer for Medical Practitioners (IC Primer or ICP) [Carruthers. 2012], to be widely distributed to doctors, medical personnel, medical professional organizations, medical schools, and hospitals in the US. The reasons why this is necessary are as follows:

Myalgic Encephalomyelitis Is Not a Fatigue Syndrome

Myalgic encephalomyelitis (ME) is a distinct neurological disease described in the medical literature since the 1930s [Gilliam, 1938] and recognized by the World Health Organization (WHO) since 1969. Classic descriptions of the disease, based on thousands of cases, [Acheson, 1959; Ramsay, 1986] and the 2011 ME ICC [Carruthers, 2011] do NOT list unexplained fatigue, or any type of perceived, self-reported fatigue, as a diagnostically useful symptom of ME. Table 2 on page 14 of the AHRQ report [Smith, 2014] clearly shows that of the eight case definitions considered by the report, only the ME International Consensus Criteria case definition does not use fatigue as a criterion for diagnosis.

Indeed, people with ME do experience profound fatigue, but so do people with other serious neurological diseases such as multiple sclerosis (MS) and other forms of damage to the brain such as traumatic brain injury (TBI). Self-reported fatigue is a common feature of many medical diseases and psychiatric disorders, and, therefore, is not useful for making a differential diagnosis. Self-reported fatigue is a subjective and often retrospectively recalled experience that cannot be objectively measured. Self-reported fatigue can only be assessed using unreliable paper-and-pencil or computer-assisted questionnaires that produce highly variable and unstable results.

There is no research that indicates there is a correlation between changes in scores on fatigue questionnaires and changes in the underlying disease process of ME. Fatigue questionnaires, therefore, are of little or no use for measuring the effectiveness of various treatments for ME. CFS, on the other hand, is based on the subjective symptom of unexplained fatigue so an argument can be made that changes in fatigue scores indicate improvement or worsening of the condition in CFS-labeled patients or CFS-labeled research subjects.

Eliminating subjective fatigue as the defining characteristic and requiring a positive diagnosis based on objectively measurable features, as opposed to the CFS diagnosis of exclusion, further refutes the spurious claims that ME is based on medically unexplained symptoms (MUS) and can be considered a functional disorder or a “bodily distress syndrome.” The authors of the ICC make a strong case, supported by published research, that ME symptoms are not medically unexplained and that ME cannot be considered a functional disorder without observable and measurable physical abnormalities.

According to the US Centers for Disease Control and Prevention (CDC), chronic fatigue syndrome (CFS) is a diagnosis of exclusion – that is, CFS cannot be diagnosed until all other diagnoses that may account for a patient’s reported fatigue are ruled out. [Fukuda, 1994] No single patient, therefore, can simultaneously qualify for both a CFS and an ME diagnosis. In other words, ME and CFS are mutually exclusive diagnoses. If a patient meets diagnostic criteria for ME, he or she cannot rationally be diagnosed also with CFS because the ME diagnosis accounts for any fatigue reported by the patient – just as a cancer, rheumatoid arthritis, or multiple sclerosis diagnosis would do. However, how can doctors rule out ME, in keeping with the CDC’s CFS diagnosis of exclusion concept, if doctors do not have reliable, peer-reviewed, up-to-date diagnostic guidelines exclusively for ME?

Doctors in the US, therefore, need to have the IC Primer so they can make the differential diagnosis of ME rather than assign patients with ME to the broad, unexplained-fatigue-based diagnostic category of chronic fatigue syndrome.

The Term ‘ME/CFS’ Is Impossible to Interpret and Causes Confusion

The mutual exclusivity of the ME and CFS diagnoses renders the term “ME/CFS,” now favored by the US Department of Health and Human Services (HHS) and used throughout the AHRQ report, impossible to interpret. Does “ME/CFS” refer to only ME, only CFS, illogically both, or some other medical condition entirely? It is impossible to tell. No single patient can qualify for both diagnoses at the same time according to the separate case definitions for ME and CFS. [Carruthers, 2011; Fukuda, 1994] For this reason, the ICC and ICP call for ME patients to be removed from the overly inclusive CFS diagnostic category rather than to be placed in some logically incoherent, unclassifiable fatigue-based illness category called “ME/CFS” or “CFS/ME”. This means that doctors need to reassess their existing CFS patients for ME using the IC Primer and, going forward, rule out ME before making any new CFS diagnoses.

How could the hybrid diagnostic term “ME/CFS” ever be classified following WHO rules and the basic principles of scientific taxonomy going back to Linnaeus and Aristotle? WHO rules do not allow any diagnostic term to be listed under more than one classification because, by definition, individual categories and subcategories must remain mutually exclusive.

ME is an established neurological disease listed in the WHO International Classification of Diseases (ICD) as benign myalgic encephalomyelitis under “Diseases of the nervous system” as G93.3 since 1969. Holmes-defined chronic fatigue syndrome [Holmes, 1988] was placed in the alphabetical index of the WHO ICD-10 in 1992 referenced to G93.3 in the tabular index. However, the WHO is silent on the relationship of alphabetical index terms to their referent in the tabular index. There is no reason to assume the WHO ever regarded the two terms, ME and CFS, as synonymous or equivalent.

In any case, it is clear that CFS has never been case-defined as a neurological disease, but only as a variable grouping of self-reported symptoms. Chronic fatigue syndrome was first defined as a fatigue-based research “operational concept” in 1988 by a CDC-led committee. [Holmes, 1988] CFS was later redefined in 1994 for further research purposes as a grouping of self-reported symptoms with 70 different variations by another CDC committee. [Fukuda, 1994] The authors of the 1994 Fukuda definitional paper did not consider CFS a neurological disease or, indeed, even a clinical entity until verified by further research.

Consistent with its 1994 CDC case definition, CFS is presently classified in the US ICD-9-CM (CM stands for clinical modification) as 780.71 under “Symptoms, Signs, And Ill-Defined Conditions.” The US ICD-9-CM was written by the National Center for Health Statistics (NCHS), a part of the CDC, and on this basis must be considered authoritative for the classification of CDC-defined diagnostic terms. The current US ICD-9-CM does not list benign myalgic encephalomyelitis, deviating from the WHO ICD-9 on which it is based.

However, in the new US ICD-10-CM, official on October 1, 2015, benign myalgic encephalomyelitis is coded as G93.3 under “Diseases of the nervous system,” as ME is now coded in WHO ICD-10. Chronic fatigue syndrome is specifically excluded from G93.3 in ICD-10-CM and coded, along with the symptom of unspecified chronic fatigue, as R53.82 under “Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified.”

How then will US doctors code the hybrid diagnostic term “ME/CFS” using the new US ICD-10-CM? The term consists of the neurological disease ME in the G-section blended, in some indeterminable fashion, with the symptom grouping CFS in the R-section. In practice, doctors will have to chose to code an “ME/CFS” diagnosis as either CFS R53.82 or ME G93.3 rendering the hybrid term “ME/CFS” ambiguous and useless for reporting and billing purposes. US doctors however, are unlikely to use the ME code because the neurological disease ME is unfamiliar to them or has been misrepresented to them as another name for CFS. “ME/CFS” in practice will become only the symptom grouping CFS and not the neurological disease ME unless doctors are informed, using the IC Primer, how to differentiate ME from CFS.

Doctors Need Basic Information on ME to Avoid Harming Their Patients

Very few doctors in the US now have the information, training, and experience needed to recognize and diagnose ME. Doctors currently give the inappropriate broad diagnosis of CFS to their patients who have the neurological disease ME. The result is that CFS presently includes patients both with and without ME. The common CFS misdiagnosis creates a medically dangerous situation for patients with ME and greatly increases their risk of serious, or even permanent, iatrogenic harm.

ME, according to the ICC, is characterized by an abnormal biological response to physical or mental exertion that the authors call post-exertional neuroimmune exhaustion (PENE). PENE is an objectively measurable, profound dysfunction of the body’s neurological, immunological, cardiovascular, and energy-production systems that can result in prolonged, or permanent, disability.

Iatrogenic harm to ME patients is especially likely now because the CDC and medical organizations informed by the CDC do not advise cautioning ME patients about the extreme risks posed by exercise. Instead, doctors are dangerously encouraging misdiagnosed ME patients to exercise or participate in so-called graded exercise therapy (GET) based on the CDC recommendations for CFS.

Without doubt, thousands of cases of extensive, or lifetime, disability in the US result every year from the inability of doctors to recognize, diagnose, and properly treat ME. It is essential for the nation’s health that US Department of Health and Human Services immediately begin informing doctors about ME and begin distributing the IC Primer to doctors before more people with ME are condemned to a lifetime of disability because of current unsafe medical advice and practices.

HHS has already had three years, since the ICC were published in the Journal of Internal Medicine, to inform doctors about ME and the grave risks to their patients caused by a missed ME diagnosis. HHS could easily and inexpensively begin almost immediately to advise doctors about ME by placing accurate information about ME on HHS websites with links to the ICC and IC Primer.

The CDC has distributed thousands of printed copies of their CFS Toolkit [CDC, undated] to doctors. Every one of these doctors urgently needs to have also a printed copy of the IC Primer so he or she can recognize and diagnose ME and avoid causing harm to their ME patients by misdiagnosing them with CFS.

The CDC CFS Toolkit Places ME Patients At Risk

The diagnostic guidelines in the CFS Toolkit are based almost word-for-word on a 20-year-old CDC theoretical research case definition. [Fukuda, 1994] This research framework was designed to search for illness patterns that might indicate the presence an identifiable disease. No such distinct illness pattern has ever been found by the CDC. However, the CDC is still using their broad 1994 research criteria in the current CFS Toolkit as diagnostic criteria to assign patients to a hypothetical symptom complex called chronic fatigue syndrome that has come mistakenly to be regarded as a specific diagnosis. As a consequence, the umbrella CFS diagnostic category contains many missed differentiable and treatable diagnoses that were not sufficiently investigated before a patient was assigned to the general symptom CFS category. These missed diagnoses are then left medically untreated. Foremost of these missed diagnoses is myalgic encephalomyelitis.

Placing ME within the broad CFS category puts ME patients at risk because of the objectively measurable, abnormal biological response to exercise or exertion characteristic of the disease. Exercise that may benefit CFS-labeled patients solely with clinical depression or the single symptom of chronic fatigue may cause irreparable harm to patients with ME. The CFS Toolkit fails to list ME in the section “Illnesses that may resemble CFS” despite myalgic encephalomyelitis having been well-described in the medical literature for many decades and having been listed by the WHO ICD as a neurological disease for 45 years. Presumably, with ME now readily diagnosable by US doctors using the 2012 IC Primer, updates to the CFS Toolkit will list myalgic encephalomyelitis as an exclusionary disease for a CFS diagnosis.

The “Treatment and Management” portion of the CFS Toolkit, along with general platitudes on “coping skills, “emotional issues,” sleep issues” and the treatment benefits of cognitive behavioral therapy (CBT) for “some patients with CFS,” has a section on graded exercise therapy (GET). Graded exercise therapy is defined in the Toolkit as starting at a low basic level of exercise and gradually increasing “to a level where people can go about their daily life.”

The Toolkit also now states that, “The GET Guide 2008 by Chronic Fatigue Syndrome/ME Service at St. Bartholomew’s Hospital can be helpful in structuring your graded exercise plan.” This unscientific and outdated guide is as unsafe for ME patients as the Toolkit. The GET Guide is now only available online archived at a Danish “functional disorders” website. The St. Bartholomew’s Hospital GET Guide “aims to help you overcome limitations caused by the symptoms of chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME)” by gradually increasing exercise tolerance – similar to expecting diabetics to improve their sugar metabolism by gradually increasing their daily sugar intake.

Although the Toolkit warns to avoid “the push-crash cycle,” no mention is made of the fundamentally altered biological response of people with ME to exercise and the possibility of increased disability and permanent relapse. In contrast, the IC Primer has a chart on pages 3 and 4 that lists 25 physiological functions in which the response of ME patients differs from the normal response.

Another grave risk posed for ME patients misdiagnosed using the CFS Toolkit rather the appropriate IC Primer is failure to recognize, monitor, and treat the serious known cardiovascular abnormalities associated with ME. The CFS Toolkit makes no mention of any cardiovascular problems whatsoever being associated with CFS. The IC Primer on page 6 lists with references these cardiovascular and autonomic impairments associated ME:

Insufficient increase in blood pressure (BP) on exertion, low blood pressure and exaggerated diurnal variation may be due to abnormal blood pressure regulation, inverse relationship with fatigue, reduced blood flow and vasculopathy, arterial elasticity dysfunction – hyper-elasticity/contractibility of arterial walls, elevated response to acetylcholine, increased arterial wave reflection, ‘small heart’ with small left ventricular chamber, cardiac and left ventricular dysfunction, reduced heart rate variability during sleep suggests a pervasive state of nocturnal sympathetic hyper-vigilance and may contribute to poor sleep quality, low circulating erythrocyte volume (~ 70% of normal). Vascular abnormalities suggest there is insufficient circulating blood volume in the brain when in an upright position, and blood may pool in the extremities.

Doctors need to be aware of these serious possible cardiovascular impairments when treating and monitoring their ME patients. If an ME patient is given a CFS diagnosis and the CFS Toolkit is a doctor’s only guidance, how would the doctor ever know to be alert for and treat these impairments?

Similarly, in each of the sections – Post-Exertional Neuroimmune Exhaustion, Neurological Abnormalities, Immune Impairments, and Energy Production and Ion Transport Impairments – the ICP has detailed information useful for doctors, in contrast to the vague general information of the CFS Toolkit. The ICP has a step-by-step procedure for the ME diagnostic and reassessment process with checklists and charts to assist and guide doctors in the initial evaluation of patients, what medical tests to order, the diagnostic criteria, and how to monitor and reassess ME patients.

The IC Primer also lists over 30 medical laboratory tests and imaging studies specifically useful for the diagnosis and monitoring of ME, in addition to standard laboratory screening tests. The CFS Toolkit only recommends the standard laboratory tests to screen for other possible diagnoses based on the CDC’s CFS as a diagnosis of exclusion concept. The IC Primer lists the 2-day cardiopulmonary exercise test (CPET) [VanNess, 2007] as an objective confirmation of the characteristic ME feature of an abnormal biological response to exertion. There is no objective test for the characteristic CFS feature of self-reported fatigue.

The IC Primer has extensive treatment recommendations for ME including specific pharmaceutical and non-pharmaceutical treatments. The Toolkit “Drug therapies” section only gives general medication advice with no specific drugs mentioned. The section is mostly about what to avoid. The “Non-drug therapies” section includes, yoga, light exercise before bed, puzzles, and word games.

Very importantly, the ICP has a sections on pediatric considerations and pediatric personalized ME treatment. ME presents differently in children and requires specialized treatment. Knowledge of ME in children by doctors can help prevent the abuse of children and their parents caused by psychiatric misdiagnosis and inappropriate psychiatric treatment of the neurological disease ME in children. Parents of children with ME are sometimes accused of encouraging illness symptoms in their children to gain attention and a sense of importance. The specific pediatric considerations and diagnostic procedures in the IC Primer can help counter this abuse of the parents of children with ME. The CFS Toolkit makes no mention of pediatric CFS.

The diagnostic guidelines of the ICP eliminates the arbitrary 6-month waiting period of the CDC criteria from when symptoms first appear and the condition can be diagnosed. It is critical that ME be diagnosed as soon as possible so patients can be advised they need total rest and to avoid exercise and overexertion. It may be too late for this medical advice after six months have passed. Early diagnosis and treatment result in the best prognosis and limits the risk of severe or permanent disability. Pioneer ME doctor A. Melvin Ramsay stated:

The clinical picture of myalgic encephalomyelitis has much in common with that of multiple sclerosis but, unlike the latter, the disease is not progressive and the prognosis should therefore be relatively good. However, this is largely dependent on the management of the patient in the early stages of the illness. Those who are given complete rest from the onset do well… [Emphasis added]

The IC Primer was written by 26 highly qualified expert authors, representing 12 countries, who have collectively diagnosed and treated over 50,000 patients with ME and have over 500 years of experience. The ICP is supported by published research with over 150 references.

In contrast, the CDC CFS Toolkit was written by anonymous authors who do not support their diagnostic and treatment guidelines with a single reference. Doctors and other medical providers are expected to take the recommendations of the CFS Toolkit on faith because it was written by employees of the CDC and has a photograph of a man in a white coat on the cover.

The Current HHS/IOM Redefinition of “ME/CFS”

Instead of protecting the nation’s health and economic viability by supporting and distributing the IC Primer, which is available for use free of charge, the US Department of Health and Human Services is unwisely creating more confusion, delay, and medical misinformation by hiring the unqualified Institute of Medicine (IOM) for $1,000,000 to oversee the creation of unneeded diagnostic guidelines for an unclassifiable new hybrid fatigue illness HHS is calling “ME/CFS.”

The IOM is unqualified to create diagnostic guidelines for diseases because of its institutional conflict of interest and its unjustifiable policy of using panels composed mostly of inexperienced non-experts to develop diagnostic criteria. The HHS/IOM “ME/CFS” panel has eight non-experts and only seven members with significant knowledge and experience in the field. Of these seven experienced members on the panel, four have previously participated in CDC-organized continuing medical education courses recommending the use of the overly broad 1994 CDC CFS case definition and exercise as a treatment for CFS. The CDC online courses fail to acknowledge that ME is a separate neurological disease requiring its own case definition and diagnostic guidelines that caution against using exercise as a treatment.

How could the recommendations produced by an unqualified and inexperienced HHS/IOM panel possibly have more credibility, reliability, and utility than the recommendations of the existing ICC and IC Primer written by 26 expert authors with collectively over 500 years of experience in the field of ME? It would be utter folly and a tragic waste for HHS to place the recommendations of an unqualified and inexperienced IOM panel above the recommendations of the highly qualified expert ME ICC panel.

The diagnostic guidelines and treatment recommendation of the HHS/IOM “ME/CFS” panel, composed mostly of neophyte, non-expert members, cannot possibly reduce the urgent need for wide distribution of the IC Primer for ME. Almost all of the worldwide experts on ME and CFS have agreed, on the record, that the product of the HHS/IOM “ME/CFS” panel will create more confusion, harm patient care, and impede future research. It is, therefore, vitally important for the reasons given above that doctors have the IC Primer now so they can recognize and diagnose ME and give their patients with ME the best chance to limit the disability caused by the disease and to provide ME patients the best quality of life until more effective treatments and a cure are found.

Gilliam, A. G. Epidemiological study on an epidemic, diagnosed as poliomyelitis, occurring among the personnel of Los Angeles County General Hospital during the summer of 1934. United States Treasury Department Public Health Service Public Health Bulletin, US Treasury Dept. No. 240. Washington, DC: United States Government Printing Office.1938.

I don’t believe in the trem “ME/CFS” any more. I know I wrote a post about previously, but I was still a newbie. There is a disease called Myalgic Encephalomyelitis (ME), which is diagnosed by the International Consensus Criteria. It always involves the appearance of neurological symptoms (Post-Exertional Neuroimmune Exhaustion) shortly after exercise. These symptoms may or may not include fatigue.

Chronic Fatigue Syndrome (CFS) is characterized by severe fatigue, which may or may not be exacerbated by exercise. It is not a disease, it is a syndrome, a cluster of symptoms. I maintain that it is a result of any one of 200 undiagnosed autoimmune diseases.

ME and CFS should not be combined. They are opposite in important ways.

But I got the same general outline of ME as he does with ME/CFS. He has the idea of limbic kindling in the limbic cortex. I have central sensitization in the limbic cortex.

He has the movement towards Th2 dominance (T-helper cells that promote allergy, not autoimmunity), because Th1 is downregulated, like I do. But for me, this is due to the initial viral infection (enterovirus, EBV, HHV-6 etc. which downgrade Th1) and radioactive toxins promoting TGF-beta, which also downgrade Th1. He has overactivity in the pituitary doing it. My pituitary is trashed, and all it was doing was spitting out prolactin and TSH from a pituitary tumor. Everything else was underactive.

They mention leaky gut. This is caused by anti-inflammatory TGF-beta wiping out Th22 cells.

Jason talks about increased NMDA receptor activity. But this is because of an increase in the number of NMDA receptors, not an upgrade in the activity per cell. And glutamate and GABA have to be created for all these cells, and the body robs alpha-ketoglutarate from the Krebs cycle to power them, reducing ATP in the mitochondria. There’s not enough of anything to go around with all these neurons sprouting.

He doesn’t have an explanation for post-exertional neuroimmine exhaustion, which results from TGF-beta being released from muscles 24 hours after exercise, which reduces follistatin levels, weakens muscles, leads to fibrotic tissue replacing muscle fiber, and further reduces Th1. This is key.

And of course nothing about reduced IDO, which is a straight-up inference from depleted Th1, which reduces catabolism of tryptophan and leads to disturbances in the kynurenine pathway (a classic neurological effect), and too much serotonin. Insulin delivers tryptophan to cells, and is part of the disease process. He acknowledges high serotonin levels without giving the reason, or mentioning that this might lead to the central sensitization in the first place, where too many neurons are produced. Serotonin receptors also give off more TGF-beta.

Since the neurons connect to a place in the hippocampus that involves the default mode network (DMN), and there is not enough GABA, the brain cannot switch out of the resting state to perform tasks, or multitask. This leads to paralysis is severe ME.

Since the publication of the ICC in 2011, Jason has published studies using the ICC, to his credit. And his research (along with Maes) is better than the run-of-the-mill ME/CFS quackery. But we need experts in internal medicine, neurology, and immunology involved in ME research. Most of all, we need to abolish the ME/CFS label, which contaminates studies with heterogeneity, and causes harm to ME patients.